Vanessa Yap

Is the Present Definition of Health Care–Associated Pneumonia the Best Way to Define Risk of Infection with Antibiotic-Resistant Pathogens?

Health care-associated pneumonia (HCAP) is associated with an increased risk of infection with multidrug-resistant pathogens compared with community-acquired pneumonia. Recent studies suggest that the designation of HCAP is a poor predictor of resistant pathogens and that antibiotic coverage for multidrug-resistant pathogens is not necessary in all patients with HCAP. This article reviews existing literature on HCAP, discusses the utility of the current definition of HCAP in identifying patients at risk for potentially drug-resistant pathogens, and compares how well the current HCAP designation predicts the risk of drug-resistant pathogens with other proposed algorithms for doing so.

New therapeutic options for noncystic fibrosis bronchiectasis.

PURPOSE OF REVIEW Patients with noncystic fibrosis bronchiectasis (NCFB) share many of the respiratory symptoms of cystic fibrosis and often are provided therapies effective in cystic fibrosis, often without clear evidence of benefit. There are currently no approved therapies for NCFB, but in recent years, there has been increased interest in developing new therapies due to the increasing prevalence and perceived unmet needs. This review is meant to provide the most recent information to clinicians about currently available and pipeline therapies for NCFB. RECENT FINDINGS Inhaled antibiotics may provide effective bacterial suppressive therapy with an acceptable safety profile in adults with NCFB, although evidence of improved outcomes is limited. Inhaled hyperosmolar agents such as hypertonic saline and mannitol are promising but study results have been mixed. Macrolide antibiotics have anti-inflammatory properties and, in several randomized controlled trials, demonstrated the benefit of chronic low-dose treatment. Other anti-inflammatory agents that have shown promising preliminary results include statins and neutrophil elastase inhibitors. SUMMARY There is high-quality evidence supporting chronic low-dose macrolide therapy in patients with NCFB. There is limited evidence of benefit of other therapies, including inhaled antibiotics and pharmacologic agents to enhance mucus clearance.

Reversible bronchiectasis in an adult: a case report.

Bronchiectasis is classically defined as irreversible bronchial dilatation that represents the sequelae of chronic airway inflammation and is permanent, reflecting the presence of bronchiectasis. It is increasingly being recognized with the wider availability of high-resolution computed tomography. In contrast to adults, children with noncystic fibrosis bronchiectasis may have resolution or significant improvement in bronchial dilatation. We report a case of reversible bronchial dilatation in an adult as evidenced by high-resolution computed tomography, which demonstrates that, although quite rare in adults, spontaneous resolution may occur.

A 26-year-old man with a slowly growing heterogeneous intrathoracic mass.

A 26-year-old man presented with complaints of leftsided chest pain and shortness of breath with moderate exertion, of 6 month duration. The patient had a history of asthma but reported that the exertional shortness of breath was not like his typical asthma symptoms and was not associated with wheezing. The left-sided chest pain was a dull and constant ache, without any aggravating or relieving factors. The patient denied fever, chills, night sweats, cough, or weight loss. Past medical history was signifi cant for asthma since childhood, which was well controlled on budesonide inhaler. He had received a gunshot wound 11⁄2 years earlier and had abdominal surgery at that time “to stop the bleeding,” but records of the procedure were not accessible. Examination revealed a young man who appeared well and in no distress. Vital signs were as follows: temperature, 36.6°C ; heart rate, 80/min, regular; BP, 120/76 mm Hg; respiratory rate, 15/min; and oxygen saturation, 98% on room air. There was no pallor, icterus, or cyanosis. No jugular venous distension, thyromegaly, or cervical lymphadenopathy was discerned. Lung examination revealed diminished breath sounds at the left base with decreased vocal resonance and increased dullness to percussion. Cardiac examination revealed normal heart sounds without any murmur. No organomegaly or localized tenderness was noted on A 26-Year-Old Man With a Slowly Growing Heterogeneous Intrathoracic Mass